后路硬脊膜切开治疗高位腰椎间盘突出症

Treatment of upper lumbar disc herniation by using posterior dural incision

目的 观察后路硬脊膜切开椎间盘摘除术治疗单间隙高位腰椎间盘突出症的临床疗效.方法 通过治疗单间隙高位腰椎间盘突出症患者35例,腰2～3间隙13例,腰3～4间隙22例;共分为两组,其中A组患者16例,行后路硬脊膜切开椎间盘摘除后外侧植骨融合术;B组患者19例,行侧后方椎间盘摘除椎间融合内固定术,对比两组术中出血量和手术时间,术后平均随访2年4个月,并行日本整形外科协会（JOA）评分和功能障碍指数（ODI）评估.结果 A组患者出血量为150 ～340 ml,平均253 ml;B组患者出血量为320～ 670 ml,平均478 ml.A组患者手术时间为75 ～125 min,平均93 min;B组患者手术时间为105～ 165 min,平均137 min.A组患者术前JOA评分为（10.30±2.27）分,ODI为（54.31±11.07）％,随访期末JOA评分为（24.10±1.26）分,ODI为（18.27±5.81）％,术前与随访期末比较差异有统计学意义（P＜0.05）;B组患者术前JOA评分为（10.60±2.33）分,ODI为（53.93±10.46）％,随访期末JOA评分为（24.50±1.25）分,ODI为（18.02±5.78）％,术前与随访期末比较差异有统计学意义（P＜0.05）;两组间各随访期比较差异无统计学意义（P＞0.05）.结论 经后路硬脊膜切开的方法治疗高位腰椎间盘突出症,术后患者也能达到满意的临床效果.

Objective To study clinical efficacy of posterior dural incision and discectomy for single gap upper lumbar disc herniation.Methods There were 35 cases of single gap upper lumbar disc herniation,including 13 cases of lumbar 2-3,and 22 cases of lumbar 3-4.All patients were divided into two groups.Sixty cases were subjected to posterior dural incision and discectomy,followed by posterolateral fusion surgery （group A）,and 19 cases to discectomy,followed by intervertebral fusion and internal fixation （group B）.Blood loss and operative time during operation were observed.During the postoperative average follow-up period of 2 years and 4 months,the Japanese Orthopaedic Association （JOA） score and oswestry disability index （ODI） were assessed.Results The amount of blood loss during operation in group A and group B was 150-340 ml （mean 253 ml） and 320-670 ml （478 ml） respectively.The operative time in group A and group B was 75-125 min （mean 93 min） and 105-165 min （mean 137 min）.There were significant differences in JOA score （10.30 ±2.27 vs.24.10 ± 1.26） score and ODI [（54.31 ± 11.07）％vs.（18.27 ± 5.81） ％] before operation and after the final follow-up in group A （P ＜ 0.05）.There were significant differences in JOA score （10.60 ±2.33 vs.24.50 ± 1.25） and ODI [（53.93 ± 10.46）％ vs.（18.02 ± 5.78） ％] before operation and after the final follow-up in group B （P ＜0.05）.However,there was no statistically significant difference in the follow-up intervals between group A and group B （P ＞ 0.05）.Conclusion Posterior dural incision is an effective method for the treatment of upper lumbar disc herniation.